Provider Demographics
NPI:1235132796
Name:LOAISIGA, RAUL ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ERNESTO
Last Name:LOAISIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 NORTH EXPRESSWAY 77/83 SUITE 206
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4780
Mailing Address - Country:US
Mailing Address - Phone:956-350-5500
Mailing Address - Fax:956-350-4965
Practice Address - Street 1:4770 N EXPRESSWAY # 7783
Practice Address - Street 2:STE 206
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4120
Practice Address - Country:US
Practice Address - Phone:956-350-5500
Practice Address - Fax:956-350-4965
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158800607Medicaid
TXG77907Medicare UPIN